Zwelling: Response to health care reform way overblown

By Leonard Zwelling

Updated 6:44 pm, Friday, July 18, 2014

The Affordable Care Act has generated enormous controversy given the actual consequences of the bill.

Supporters of the legislation ascribe all sorts of good to the law. Seven-and-a-half million people now have insurance. People with pre-existing conditions cannot be discriminated against. Children under 26 can be carried on their parents' policies. Medicaid has been expanded in some, mostly Democratic, states. All true.

The bill's detractors cite rising health insurance premiums to defray the costs of sick people who are newly insured as a consequence of Obamacare. They bemoan the additional financial burden on medium-sized businesses to either insure more workers or pay a penalty.

Of course, the fact that the president has the goal posts on wheels and keeps changing the dates of implementation while he oversaw what has got to be the worst information system rollout in history doesn't help. Most of this is true, too.

The real problem is misunderstanding what the bill intended to do, what it actually does, and where it stands in a continuum of change in the American health care system.

The bill was intended to lock in the current system of paying for health care. It had nothing to do with health care delivery, its cost or its quality. It solidified the current fee-for-service model, and now the government will assist in giving more people access to it through insurance exchanges and subsidies for the poor, plus the expansion of Medicaid and the mandate to buy insurance forcing everyone in, especially the healthy young.

What it actually does is even less, thanks to the Supreme Court. The court threw a monkey wrench in much of that when it declared Medicaid expansion optional on a state-by-state basis, and most of the Republican states rejected expansion beyond their existing level of coverage. This was despite the fact that the federal government would have covered 100 percent of the cost of expansion until 2017 and 90 percent thereafter (Medicaid is paid for by both the federal government and the states). The penalty for not expanding, loss of a state's current level of Medicaid funding, was struck down by the court. Thus, there were no consequences for doing nothing to help the poor, and many states opted not to expand Medicaid. Texas was one of these.

The furor that followed its passage stems from many things. First, some people genuinely do not like any government intervention into health care. Of course, when you combine those serviced by Medicare, Medicaid, CHIP, the military, the VA and the Indian Health Service, that is almost half of all Americans. The government has been deeply imbedded in health care for over 50 years.

Second, Republicans don't like to lose. Neither do Democrats. The legislative tricks played on the Rs by the Ds to get this passed would leave a sour taste in the mouth of any opponent.

Third, the Republicans really do not like President Obama. This is humorous because this bill was generally a product of the Congress, not the White House, and was based on Republican ideas from the Heritage Foundation. It should have been labeled PelosiCare, as it was former House Speaker Nancy Pelosi who rammed the Senate version of the bill through the House once the Dems lost their veto-proof majority in the Senate with the death of Ted Kennedy and the election of Scott Brown, R-Mass. Had the bill gone to conference committee to reconcile the House-passed and Senate-passed versions, which were not identical, the Senate R's would have filibustered it to death.

Fourth, and most critically, the Obama administration never told the truth about this bill. The president kept saying that "if you like what you have you can keep it," which was either duplicitous or a lie or both. He knew better, or should have.

Put it all together and you get a bill that aimed low, missed and then resulted in a firestorm of controversy blown way out of proportion for political purposes.

The Affordable Care Act was never meant to completely fix the American health care system. It was meant to be a start in that direction.

Whether any lasting good will actually come from this legislation remains to be seen. We can always hope.

Or, we can press the reset button and have a meaningful debate about whether health care is a right or a privilege and pass legislation consistent with the chosen philosophy. That would be a real start.

That's not likely to happen, either, because in the end, health care reform was never about health care. It was about money. As my friend Norman Ornstein of the American Enterprise Institute said in 2008: "Everyone's idea of health care reform is the same. I pay less!"